Infrasternal & Infrapubic Angles, and Improving Movement & Breathing Strategies

Want to learn about breathing? How it impacts movement? What are my thoughts are on the FMS? You’ll learn that and more on The Gamut of Peformance Podcast that I was recently featured on. A great podcast hosted by my boi Juan Perez, who you’ll definitely want to check out. Click below to give it a listen, and check out some of the links that we discussed as well. GPP Episode 26: Zac Cupples- Infrasternal/ Infrapubic Angle, and Improving Movement & Breathing Strategies Here is a link on things asymmetrical infrasternal angle-related Here is some stuff on the infrapubic angle Learn about the infrasternal angle here Here is some stuff on narrow infrasternal angles Here is a good overview on breathing mechanics Here is a legendary infrasternal angle post by my boi and mentee, Mike Kay

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Rib Flares, Posterior Thorax, and FMS – Movement Debrief Episode 52

Movement Debrief Episode 52 is in the books. Below is a copy of the video for your viewing pleasure, and audio if you can’t stand looking at me. Here is the set list: What is a rib flare? How can rib flares be improved? What is the posterior mediastinum? What is moving when we seek posterior thorax expansion? What tests and interventions can be used in regards to posterior thorax expansion? How far have we come from the FMS/SFMA? What have we learned from the FMS/SFMA? What should we be addressing now instead of the FMS/SFMA? If you want to watch these live, add me on Facebook or Instagram.They air every Wednesday at 7pm CST. Enjoy! and the audio version…                  Here were the links I mentioned: Sign-up for the Human Matrix in Seattle, WA on September 15-16th here Sign up for the Human Matrix in Kansas City, KS on October 27-28th here   Sign-up for the Human Matrix in Portland, OR on November 10-11 here Here is a move for a narrow infrasternal angle a wide infrasternal angle An asymmetrical infrasternal angle Mechanics of the respiratory muscles Here is the posterior thorax expansion activity I like courtesy of Lucy Hendricks. Here’s a signup for my newsletter to get nearly 3 hours and 50 pages of content, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies:

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Recommended Resources

I oftentimes get asked what resources I recommend. The resources listed below have been essential at putting me down the path that I am currently going, and have shaped how I practice today. The cool thing about this list? None of these are set in stone. If I find a better resource, or one of the blogs I recommend starts to resonate with me less, it leaves the list (no pressure). I want to give you guys the most up-to-date resources as humanly possible, so please check back here frequently. If you’d like articles and such that are tripping my trigger as of late, you may want to sign up for my newsletter. You’ll also get some access to almost 3 hours and 40+ pages worth of exclusive content on pain and breathing. Here are my resources: Foundational Sciences Video series Makemegenius – A youtube page dedicated to explaining scientific concepts that a kid could understand. Crashcourse – Another series of short videos explaining complex scientific topics and more in 15 minutes or less. I wish I had this in undergrad. Books Gilroy Atlas of Anatomy – Easily the best paper anatomy atlas you can find in the land. The angles drawn, the clarity of pictures, this atlas has it all. Wait until you see the subocciptals from the side. #mindblown Guyton and Hall Textbook of Medical Physiology – Easily the best and most comprehensive physiology textbook in the land, the depth at which this book dives into with concepts

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Continuing Education: The Complete Guide to Mastery

75 That’s my number. No, not that number.   75 is the number of continuing education classes, conferences, home studies, etc that I’ve completed since physical therapy school. Though the courses are many, it was probably too much in a short period of time. When quantity is pursued, quality suffers. Sadly, I didn’t figure out how to get the most out of each class until the latter end of my career. Two classes in particular stand out: Mobilisation of the Nervous System by the NOI Group, and ART lower extremity. Yes, the content was great, but these classes stood out for a different reason. You see, instead of just doing a little bit of prep work, I kicked it up a notch. I extensively reviewed supportive material, took impeccable notes, and hit all the other essentials needed to effectively learn. I was prepared, and because I was prepared I got so much more out of these classes than my typical fair.  The lessons learned in those courses stick with me to this day. For the stuff you really want to learn, I’ll encourage you to do the same. Here is the way to get the most out of your continuing education. By the time you are done reading this post, you’ll understand why I now recommend a more focused learning approach and fewer courses. Let’s see how to do it.  

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The Post Wonderful Time of the Year: Top Posts of 2013

The Best…Around Time is fun when you are having flies. It seems like just yesterday that I started up this blog, and I am excited and humbled by the response I have gotten. Hearing praise from my audience keeps me hungry to learn and educate more. I am always curious to see which pages you enjoyed, and which were not so enjoyable; as it helps me tailor my writing a little bit more. And I’d have to say, I have a bunch of readers who like the nervous system 🙂 I am not sure what the next year will bring in terms of content, as I think the first year anyone starts a blog it is more about the writing process and finding your voice. Regardless of what is written, I hope to spread information that I think will benefit those of you who read my stuff. The more I can help you, the better off all our patients and clients will be. So without further ado, let’s review which posts were the top dogs for this year (and some of my favorite pics of course). 10.  Lessons from a Student: The Interaction This was probably one of my favorite posts to write this year, as I think this area is sooooooo under-discussed. Expect to be hearing more on patient interaction from me in the future. 9) Clinical Neurodynamics Chapter 1: General Neurodynamics Shacklock was an excellent technical read. In this post we lay out some nervous system basics, and

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Course Notes: FMS Level 2

Mobility, Stability, and the Like I recently attended the FMS Level 2 course after rocking the home study. In my quest to take every con ed course known to man, I got into the functional movement people because the idea of improving movement over isolation exercise interests me. I find the way they build up to the patterns very logical, namely because they liberally use PNF and developmental principles; and they do so quite eloquently. But really, I wanted to go to this class so I could meet and learn from Gray Cook. And his segments did not disappoint. While I may not agree with everything he says, he is a very brilliant man and knows movement. The only disappointment I have to say about this course was that I did not get enough Gray and Lee. I would say I probably saw them teach 30% of the time, with another FMS instructor just running us through their algorithms. I am sorry, but if you are going to advertise Gray Cook and Lee Burton as the instructors, then I want Gray and Lee instructing me! A lot of these exercises were review for me, but there were definitely some tweaks that I liked a great deal. I think if you are new to more motor control-based exercises, this course is great for you. Just make sure you are taking it from Gray and/or Lee. Why Screen? The FMS is predominately used to manage risk and prioritize exercise selection. They look

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Chapter 15: In Conclusion

This is a chapter 15 summary of the book “Movement” by Gray Cook.   The Goal The goal of movement retraining is to create authentic unconscious movement at acceptable levels. We can develop many methods to achieve our goals, but working under sound principles is paramount. Some of the principles Gray advocates include: Focusing on how we move. Look to movement to validate or refute your intervention. Movement is always honest. When designing a movement program, we must operate under the following guidelines: Separate pain from dysfunctional movement patterns. Starting point for movement learning is a reproducible movement baseline. Biomechanical and physiological evaluation do not provide a complete risk screening or diagnostic tool for comprehensive movement pattern understanding. Our biomechanical and physiological knowledge surpass what we know about fundamental movement patterns. Movement learning and relearning follows a hierarchy fundamental to the development of perception and behavior. Corrective exercise should not be rehearsed outputs. Instead, it should be challenging opportunities to manage mistakes on a functional level near the edge of ability. Perception drives movement behavior and movement behavior modulates perception. We should not put fitness on movement dysfunction. We must develop performance and skill considering each tier in the natural progression of movement development and specialization. Corrective exercise dosage works close to baseline at the edge of ability with a clear goal. The routine practice of self-limiting exercises can maintain the quality of our movement perceptions and behaviors and preserve our unique adaptability that modern conveniences erode. Some things cannot

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Chapter 14: Advanced Corrective Strategies

This is a chapter 14 summary of the book “Movement” by Gray Cook.   Inputs Corrective exercise is focused on providing input to the nervous system.  We are allowing the patients and clients to experience the actual predicament that lies beneath the surface of their movement pattern problem. It is okay for mistakes to be made, for these errors help accelerate motor learning. Minimal cueing should be utilized, as we want to patient to let them feel the enriching sensory experience. Motor Program Retraining There are several different methods in which we can achieve a desired motor output. 1)      Reverse patterning – Performing a movement from the opposite direction. 2)      Reactive neuromuscular training – Exaggerating mistakes so the patient/client overcorrects. Use oscillations first, followed by steady resistance. 3)      Conscious Loading – Using load to hit the reset button for sequence and timing. 4)      Resisted exercise – Makes patterns more stable and durable. When you can deadlift that much, most anything is stable and durable.

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Movement Chapter 13: Movement Pattern Corrections

This is a chapter 13 summary of the book “Movement” by Gray Cook.   Back to the Basics Mobility deficits ought to be the first impairment corrected. Optimizing mobility creates potential for new sensory input and motor adaptation, but does not guarantee quality movement. This is where stability training comes in. In order for the brain to create stability in a region, the following ought to be present: Structural stability: Pain-free structures without significant damage, deficiency, or deformity. Sensory integrity: Uncompromised reception/integration of sensory input. Motor integrity: Uncompromised activation/reinforcement of motor output. Freedom of movement:  Perform in functional range and achieve end-range. Getting Mobility There are 3 ways to gain mobility: 1)      Passively: Self-static stretching with good breathing; manual passive mobilization. 2)      Actively: Dynamic stretching, PNF. 3)      Assistive: Helping with quality or quantity, aquatics, resistance. Getting Stability In order to own our new mobility, we use various stability progressions to cement the new patterns. There are three tiers in which stability is trained: 1)      Fundamental stability – Basic motor control, often in early postures such as supine, prone, or rolling. 2)      Static stability – done when rolling is okay but stability is compromised in more advanced postures. 3)      Dynamic stability – Advanced movement. We progress in these stability frames from easy to further difficult challenges. Assisted → active → reactive-facilitation/perturbations Since stability is a subconscious process, we utilize postures that can challenge this ability while achieving desired motor behavior. We can also group the various postural progressions into 3 categories: 1)     

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Movement Chapter 12: Building the Corrective Framework

This is a chapter 12 summary of the book “Movement” by Gray Cook.   A Whole Lotta P When we build our corrective framework, we must take into account the 6 P’s: 1)      Pain – Is there pain with movement? Staying away from pain improves motor control. 2)      Purpose – What movement pattern are we targeting with corrective exercise and what problem are we addressing (i.e. mobility, stability, dynamic motor control)? 3)      Posture – Which moderately challenging posture is the best starting point for corrective exercise that allows for reflexive activity? 4)      Position – Which ones demonstration mobility/stability problems and compensatory behaviors? 5)      Pattern – How is the dysfunctional movement pattern affected by corrective exercise? 6)      Plan – How can you design a plan based on findings? The goal when designing the correction is to stay in the middle ground of the autonomic nervous system while providing a rich sensory experience.  Movement pattern dysfunction is a behavior that needs to be addressed and changed.

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Movement Chapter 11: Developing Corrective Strategies

This is a chapter 11 summary of the book “Movement” by Gray Cook. Autonomics All exercise affects tone and tension. This influence is the basis for movement. The autonomic nervous system determines movement as threatening or not, which determines requisite tone. It is important to nudge movement towards further nonthreatening yet advanced stimuli.   FMS Corrections Proceeding to correct under FMS protocol is determined by screen results and changed via exercise.  We first correct mobility, next reinforce stability, then retrain movement patterns. Stability training in particular follows a sequence: 1)      Challenge posture and position. 2)      Build mid-range strength. 3)      Develop end-range stability. Movement patterns are corrected in the following hierarchy: ASLR & Shoulder mobility → rotary stability → pushup → Inline lunge → hurdle step → Deep squat   SFMA Corrections The SFMA corrective pathway is nonlinear unlike the FMS. The breakouts will tell you which direction to go to restore optimal movement. The options are also increased. Often to gain mobility, you would utilize various manual therapies or other modalities. To alter stability, taping, orthotics, braces, or anything else to increase motor control may be utilized. Movement patterns are corrected in the following hierarchy: Cervical spine → Shoulder →multi-segmental flexion & extension→ Multisegmental rotation →single leg stance → Squat Depending on how movements present, certain therapies are utilized: DN – manual therapy and corrective exercise. DP – Manual therapy and modalities. FP – Modalities and manual therapy. FN – General exercise. Exercise Categories There are several exercise types that can be utilized depending on one’s goal:

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Movement Chapter 10: Understanding Corrective Strategies

This is a chapter 10 summary of the book “Movement” by Gray Cook. Mistakes, I’ve Made a Few When we are talking corrective exercise design, people often make 4 mistakes: 1)      Protocol approach: Exercise based on category. Problem – 1 size fits all. 2)      Basic kinesiology: Target prime movers and some stabilizers. Problem – fails on timing, motor control, stability, and movement. 3)      Appearance of functional approach – Use bands and resistance during functional training. Problem – If the pattern is poor, adding challenges to it can increase compensation. There is also no pre-post testing. 4)      Prehabilitation approach – Prepackaged rehab exercises into conditioning programs as preventative measures to reduce injury risk. Problem – Design is based on injuries common to particular activities as opposed to movement risk factors. There are also certain mistakes that are often made when utilizing the FMS and SFMA: 1)      Converting movement dysfunction into singular anatomical problems. 2)      Obsessing over perfection in each test instead of identifying the most significant limitation/asymmetry. 3)      Linking corrective solutions to movement problems prematurely. The overarching rule is to address these movement deficiencies first, as we do not want to put strength or fitness on top of dysfunctional movement.   The Performance Pyramid When designing an exercise program, we look for three areas to improve performance: Movement, performance, and skill.   It is important that program design is based on the individual’s needs and has these qualities in a hierarchal fashion. For example, if one performs excellent on functional performance

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